The Aging Population in the Twenty-First Century Statistics for Health Policy (1988) / Chapter Skim
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7 Long-term Care
7 Long-term Care
Pages 135-149
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From page 135... ...
The needs of the client range from those that are solely medical to those that are basically social. Limited efforts are being made to combine the resources of the medical care and social service systems in support of the Tong-term care client.
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From page 136... ...
Can private insurance companies develop long-term care insurance plans that cover nursing home care, home health services, and social support services at a reasonable cost? Can the disparate elements that constitute the long-term care financing and delivery systems be brought together to fashion a coherent set of national policies on this important issue?
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From page 137... ...
The first is that used by the Health Care Financing Administration, the major federal agency dealing with payments for long-term care of the elderly; the second is that used in the Long-Term Health Care Minimum Data Set developed by the United States Committee on Vital and Health Statistics. Doty, Liu, and Weiner (1985)
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From page 138... ...
As a result, descriptions of behavior, rather than conditions, are used to describe the long-term care population. People in need of Tong-term care are commonly described as functionally limited or functionally disabled, those persons with a chronic physical or mental condition that impairs them so that they require the help of another person in performing everyday activities (Van Nostrand,
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From page 139... ...
In practice, however, most functional assessments of the elderly concentrate on only two areas: activities of daily living, which are personal care tasks, walking, bathing, dressing, eating, and toileting, and instrumental activities for daily living, which are selected tasks necessary for living independently in the community, such as shopping, preparing meals, doing househoic] chores, managing money, using the telephone, and taking medicines (Van Nostrand, 1985b)
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From page 140... ...
recommends that the current national measures of functional disability be expanded by adding measures of cognitive, social, and emotional functioning, including behavior problems and mood disturbances, so that comparable information may be gathered from community and institutional populations. The use of such measures would appear to be most relevant for supplements on aging in the NHIS, longitudinal studies on aging, and surveys of patients in nursing homes and other institutions.
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From page 141... ...
The 1982 and 1984 National Long-Term Care Surveys conducted by the Health Care Financing Administration and the Office of the Assistant Secretary of Health and the 1984 Supplement on Aging/National Health Interview Survey conducted by the National Center for Health Statistics are useful models for the development of longitudinal surveys of the aged in the community. The National Long-Term Care Surveys collected data on persons age 65 and older who were functionally disabled and living in the community.
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From page 142... ...
from all persons age 55 and older in the original sample of persons in the 1984 Supplement on Aging of the National Health Interview Survey, now known as the Longitudinal Study on Aging. The National Nursing Home Survey conducted by the National Center for Health Statistics in 1977 and 1985 is a useful model for longitudinal surveys of the institutional elderly.
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From page 143... ...
Providers of Care Long-term care for the elderly is delivered in health facilities such as nursing homes, chronic disease hospitals, mental health facilities, and rehabilitation centers; in housing with support services, such as board and care homes, life-care communities, psychiatric halfway houses, and residential facilities; by home-health and other agencies in the client's own home; and by social service agencies providing adult day care, income maintenance, home-delivered meals, and transportation, among other services. Inventories are available of nursing homes, psychiatric facilities, and Medicare- or Medicaidcertified providers.
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From page 144... ...
Recommendation 7.5: The panel recommends that the National Master Facility Inventory compiled by the National Center for Health Statistics from census data and state records be expanded to cover all health and social facilities providing long-term care. In addition to providers currently listed, the expansion would include board and care homes, home health agencies, and adult day-care centers.
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From page 145... ...
Recommendation 7.6: The pane] recommends that the National Committee on Vital and Health Statistics evaluate and, if necessary, revise the Long-Term Health Care Minimum Data Set's classification of types of services given by providers of long-term care.
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From page 146... ...
the National Committee on Vital and Health Statistics develop a standard definition of informal supports that distinguishes between family members and nonfam~ly members (i.e., friends and neighbors) and identifies whether the helping individual lives in the same household as the care recipient and (b)
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From page 147... ...
allocation of resources to agencies and programs. The Long-Term Health Care Minimum Data Set is currently undergoing the usual Department of Health and Human Services administrative and policy review process prior to implementation.
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From page 148... ...
Most of the national expenditures for long-term care are for nursing home or institutional care, although expenditures for noninstitutional care also have increased rapidly (Doty et al., 1985~. Estimates of nursing home care are part of the National Health Expenditure series, which was initiated in the Department of Health, Education, and Welfare and ~ currently prepared and published each fall by the Health Care Financing Administration.
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From page 149... ...
The National Medical Expenditure Survey planned for 1987 wiD collect information on health status of individuals, their medical cost expenditures, and the source of payment for the civilian population as well as for the population in nursing homes, psychiatric hospitals, and facilities for the mentally retarded. The aggregation of these data from both households and institutions will provide an overview of expenditures for long-term care.
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